Tony Spadaro Profile picture
Feb 28 9 tweets 5 min read
What can we learn from buprenorphine precipitated withdrawal in the ED/hospital? A 🧵 @AustinKilaru @JMPerroneMD @kit_delgadoMD @m_lowenstein @especially_APT @JACEPOpen @NIDAnews @PennMedicine #emergencymedicine #toxtwitter
#1 Check those COWS Scores. 4 out of 13 cases of PW, got bupe for COWS scores of less than 8 (see below). Also important to check COWS scores shortly after getting bupe to make sure they are actually getting better. Great place for ordersets to improve care
#2 PW from traditional bupe inductions is real! Definitely a concern in the fentanyl era. We had patients develop PW after greater than 12 hours (sometimes even longer) since last opioid use. people who use fentanyl might be at higher risk
#3 There is still a lot we don't know about PW! Some got better with additional bupe, some didn't. Some of what treating clinicians called PW, didn't actually have worsening COWS scores and was probably protracted withdrawal (which still sucks for patients)
#4 we have to work with our patients going through PW. Many ended up having early patient directed discharges (AMA). Not great when many were also being admitted for other reasons than their PW. I believe this an area where adjunctive meds can help
#5 Finally EM, hospitalists, generalists of all sorts should not be afraid of rx'ing bupe, especially now that the #xwaiver is gone. despite all this 7/13 patients were discharged with buprenorphine, and it is truly a life-saving med in OUD.
Lots of questions remaining re: role of micro vs macro dose, optimal COWS cutoffs, how #xylazine plays into all this, how best to treat PW when it happens
Also want to include the Twitter-less Sophia Faude who did amazing work and made major contributions to this paper

• • •

Missing some Tweet in this thread? You can try to force a refresh
 

Keep Current with Tony Spadaro

Tony Spadaro Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!

PDF

Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

Did Thread Reader help you today?

Support us! We are indie developers!


This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Don't want to be a Premium member but still want to support us?

Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal

Or Donate anonymously using crypto!

Ethereum

0xfe58350B80634f60Fa6Dc149a72b4DFbc17D341E copy

Bitcoin

3ATGMxNzCUFzxpMCHL5sWSt4DVtS8UqXpi copy

Thank you for your support!

Follow Us on Twitter!

:(